Sick notes

Excerpts from a Family Medical Dictionary

Rebecca Brown <em>Granta Books, 113pp, £10</em>

ISBN 1

This book is a memorial to the dead; Rebecca Brown is an American novelist, and here she gives an account of the death from cancer of her mother, Barbara Ann Wildman Brown. It is cut up into short chapters, each with a title that chronicles a stage in her mother's decline: "tremor", "baldness", "morphine" and so on, passing on to "cremation" and "remains". The book is very short: less like a four-square monument with weeping angels than one of those terse bricks in the wall of a crematorium.

It is written in a style that suggests the author is still in shock - that all the big words have been knocked out of her by the turn of events and she has been reduced to the simple syntax of child-hood. "My mother had always been very big on car trips. She loved to drive. Every summer when we were growing up, she'd take us somewhere . . . she'd drive up north a couple times a year to visit her family in Oklahoma."

Barbara is an independent woman and unused to being ill, so she begins by dismissing her unusual fatigue, blaming it on a virus that has left her depleted. She is first diagnosed as profoundly anaemic, and undergoes a diagnostic procedure to see if she has bleeding ulcers. A tumour is found. The family - "all of us kids" - gathers. Initial surgery is successful, but the cancer has already spread.

Visits to lawyers follow: the putting of affairs in order. There is chemotherapy. The author describes the side effects: "her nausea and her bloody mouth and ears and vagina", and the great bruise on her mother's skinny arm, caused by the insertion of the needle into her vein, that has just begun to fade when it is time for the next treatment.

From the time the cancer is found to have spread, her mother's death is expected. Brown does not question the utility of the cruel "therapy" - this is not a book that examines treatment protocols, or how the dying are dealt with, or asks us to think in the abstract about illness. Brown settles for a harsh reportage, which she feels is what she can manage. "I couldn't see her dying then. I can only see her start to die in retrospect. In retrospect she dies over and over again." Her account turns its face inwards, to the family, the hospital room, the gurney, the "plastic sheets and adult diapers and latex gloves and sponges and bottles of pills and waste disposal bags and other things you need to die at home".

This is a book in which the seeming absence of artifice is calculated quite carefully. Brown means to give us the details, but no big picture. She plants her central metaphor deliberately, on the third page. On her way to see her mother, the author flies in a light plane over a desert landscape. "I kept wondering when we were going to get high enough that I wouldn't be able to see the details. Only when I was almost there, when the plane started its descent, did I realise it was never going to get any higher."

When Barbara first undergoes treatment, the author sees other patients watching a medical soap opera on TV. This surprises her. Avoidance of drama is central to her approach. Barbara is a college graduate who "majored in speech and drama and radio", but she talks like a stout American pioneer, not like a novelist's mother: "Sorry there isn't much to eat, but I figured you'd know better what you want." Throughout, the style remains artfully banal. The surgeon has a green gown. His hands smell clean. The undertaker has "a nice suit and shiny black shoes".

Few details of the family's past life emerge, but they are enough; we get an impression of a strong and loving woman, much valued by her children. Their mourning rituals are personal and touching; they wrap the body in a blanket that had comforted their mother's father when he was a soldier in the Great War. There is no orthodox religious context, but a sense of spiritual yearning filters through the tight mesh of the prose. "Betty had brought some mugwort from an herbalist in town who told her it would bring clear dreams to the dead."

As the author's mother died in 1997, this is not a despatch from the front line of bereavement. It is not, therefore, shock that has determined her style. Instead, she has made a shrewd authorial decision in favour of the bitten-back and the pared-down. Writers with literary pretensions are terrified that they will be accused of sentimentality, and one sure way to avoid it is to cut back on sentiment.

Many readers will think the book's meagre nature appropriate to the subject, as they value restraint in the face of death. How such restraint ought to be valued is a difficult question; it seems to this reader that suppressed feelings about the dead are often visited, unpleasantly, on the living.

No one would wish to slight Brown's motives, and indeed the personal cost of writing the book may have been considerable. But it should be noted that, as a literary enterprise, it is risk-free. It has the stamp of those creative writing schools where thinness of expression is taken as a guarantee of integrity. This belief is self-protective, and provides critic-proof shelter for many writers less able than Rebecca Brown; it is democratic and egalitarian, as it gives a fair chance to writers who have nothing to say. It is American, and it is of the moment, but it suggests Roy Campbell's verse of 1930 "On Some South African Novelists":

You praise the firm restraint with which they write - I'm with you there, of course:They use the snaffle and the curb all right,But where's the bloody horse?

Hilary Mantel's most recent book is Giving Up the Ghost (Fourth Estate)